More patients would have health insurance. That would reduce the likelihood they would turn to emergency rooms for care. And while Medicaid reimbursements fall short of the cost to provide care to patients, it would provide some guaranteed reimbursement for those services, says Alex Mullineaux, director of community and government relations for CaroMont Health.

“It’s better to have someone coming into your hospital paying 60% to 70% of costs, than zero,” he says.

The Gastonia-based health-care system is parent to the 435-bed Gaston Memorial Hospital.

But Medicaid expansion is no longer a guaranteed part of health-care reform after the U.S. Supreme Court ruled in June that states can opt out of expanding their programs. Through health-care reform states would have offered Medicaid coverage to anyone earning less than 133% of the federal poverty level starting in 2014.

Costs for Medicaid are shared by the federal government and the states.

More than 17 million people were expected to enroll in Medicaid, including more than 1 million in the Carolinas. That figure is now in flux after a number of states, including South Carolina, have indicated they intend to opt out of the expansion.

North Carolina has not announced its plans.

“It may very well create a system across the country that’s very much out of balance,” says Don Dalton, spokesman with the N.C. Hospital Association.

Winston-Salem-based Novant Health saw its Medicaid reimbursements fall $104 million short of the cost of providing care in 2011.

But it spent $124 million on charity care and another $61 million on bad debt. Medicaid expansion should help offset those costs, says Marci Wilding, director of government relations for Novant, parent of Presbyterian Healthcare in Charlotte. “What we want to see is greater access,” she says.

Expanding Medicaid is integral to the Affordable Care Act’s requirement that most Americans carry health insurance by 2014, says Joe Piemont, president and chief operating officer of Carolinas HealthCare System in Charlotte.

“If you allow pieces of it to unravel, I don’t know what the consequences would be,” he says.

Hospitals have agreed to a reduction of their Medicare reimbursement rates to fund that expansion. Piemont notes the expansion also is being paid for through taxes. “As a taxpayer, you’re going to pay for it whether you get it or not,” Piemont says.

And, he adds, Carolinas HealthCare is already caring for these patients whether it receives compensation or not. Medicaid will help bridge that gap for those costs.

Carolinas HealthCare estimates its Medicaid reimbursements fell $145 million short in 2011. It is reimbursed about 80 cents for every dollar it spends on care.

About 15.5% of its patients utilize Medicaid.

CaroMont expects reimbursements from Medicare and private insurers will continue to be squeezed, Mullineaux says. He adds his biggest concern is that uncompensated care will continue to rise.

“At the end of the day we’re going to have to continue to find ways to provide high-quality care, like we pride ourselves on doing, but doing it at lower and lower costs,” he says.